Allogeneic Hematopoietic Stem Cell Transplantation in patients with Acute Myeloid Leukemia : a personalized approach

The majority of patients with newly diagnosed acute myeloid leukemia (AML) obtain complete hematological remission (CR) after induction chemotherapy, but the incidence of relapse is considerable despite chemotherapeutic consolidation therapy. Currently, post-remission treatment (PRT) for the prevention of relapse may include continued chemotherapy, autologous hematopoietic stem cell transplantation (HSCT), or allogeneic HSCT (alloHSCT). Although alloHSCT is associated with the lowest incidence of relapse, counterbalancing non-relapse mortality (NRM) may compromise overall outcome. The decision to perform an alloHSCT for patients with AML in first CR depends on the assessment of risks and benefits (ie, mortality and relapse risk reduction), which is based on disease features, but also factors related to patient characteristics, transplantation procedures and type of donor. Such a risk versus benefit evaluation of alloHSCT has evolved into a personalized approach for patients with AML in first CR. The studies described in this thesis address the benefits of alloHSCT identifying different AML patient subgroups with improved outcome following alloHSCT. Secondly, the studies in this thesis addressed morbidity and mortality following alloHSCT. Lastly, this thesis discussed the value of alloHSCT as PRT in specific AML subgroups, potential challenges with respect to alloHSCT-related NRM, and statistical considerations analyzing PRT for AML. A personalized transplant decision approach for patients with AML in first CR was presented, which may be applied in daily clinical practice.

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